Poems and Tears for 'Silent Mentors' Spark a Surge of Cadavers in Taiwan

Medical Students Bond With Families to Quell Traditional Resistance to Donating Bodies

By

Ian Johnson

Updated April 22, 2009 12:01 a.m. ET

HUALIEN, Taiwan -- A young medical student stood in front of a corpse as sobbing filled the operating room.

The aspiring doctor, Hsu Jun-k'ai, worked up the nerve to glance at the relatives crying next to him. Tears trickled down his own cheeks. But the surgery wasn't a failure. It hadn't even begun.

Mr. Hsu was taking part in an elaborate farewell for eight people who had donated their bodies to Tzu Chi University's medical school for use in a surgery-simulation class. Medical schools around the world have ceremonies to honor donors, but Tzu Chi (pronounced Seh-Gee) is taking the practice to unusual levels.

By the time students here wield their scalpels, they will know the dead intimately, composing poems and slide shows to them, writing their biographies and sometimes lighting incense in their honor. When they are finished, the students will carry the donors' coffins to the crematory, mourning them as their "silent mentors" who taught them with their bodies.

Extra Care for the Dead

Ian Johnson/The Wall Street Journal

The reason for such care lies in the origins of Mr. Hsu's university. Tzu Chi is the brainchild of one of Asia's most charismatic religious figures, Cheng Yen, a 72-year-old Buddhist nun who in the 1960s founded the Buddhist Compassion Relief Tzu Chi Foundation. Now the Chinese-speaking world's largest nongovernmental charity, it last year channeled more than $300 million in private donations to victims of natural disasters around the world.

Ms. Cheng has broader ambitions. In the 1970s and '80s, Tzu Chi was part of a social and religious awakening in Taiwan that helped undermine the island's dictatorship and helped usher in democracy. The cadaver program is aimed at changing how traditional Chinese society in Taiwan and China views the human body -- and in the process, end a body deficit plaguing Taiwanese medical schools.

Traditionally, Chinese view their bodies as a bequeathal from their ancestors. This means bodies mustn't be damaged before burial. At Tzu Chi, therefore, Ms. Cheng insists that -- unlike in Western medical schools -- cadavers be sutured after being cut up. The laborious process takes days, but in the end the body is whole.

It is an argument that has deeply touched Taiwanese, whose economic miracle of the past decades has left some morally unmoored. More than 23,500 Taiwanese have willed their bodies to Tzu Chi, allowing the hospital to satisfy its educational needs and supply other schools on the island. Following Tzu Chi's lead, other schools have implemented similar commemorative services, eliminating the shortage of corpses that long hindered the Taiwanese medical establishment.

"The public was conservative about corpse donation, but Tzu Chi has made the public more open-minded," says Lu Ko-shian, director of the National Taiwan University's Graduate Institute of Anatomy and Cell Biology. "Tzu Chi changed that mindset with the power of religion."

At first, medical professionals also viewed the efforts skeptically. Tseng Guo-fang was one of them. Formerly head of anatomy at National Taiwan University's medical school, Mr. Tseng didn't see the point in the elaborate efforts to treat the bodies with so much respect. But after agreeing to teach courses at Tzu Chi, he came to appreciate it and eventually took a senior posting at the school.

At Tzu Chi University in Taiwan, people who donated their bodies to science are honored as medical students' most valuable teachers.

"I was trained as a hard-core scientist and this didn't make sense to me," says Mr. Tseng. " But I began to see that there's more to teaching a student than just technical ability; we need to create compassionate doctors too."

The efforts are spreading to China, where hospitals are also chronically short of corpses. Nine of the students in the February workshop in Hualien were from Shanghai. Western observers have been likewise impressed.

"It's something that we can learn from," said Sylvia Cruess, former director of medical services at McGill University in Montreal, who recently witnessed one of the Tzu Chi ceremonies.

The farewell ritual begins anew each summer before classes begin, when students like Mr. Hsu fan out from Hualien, a small city on the rocky coast of eastern Taiwan, to visit the donors' families.

After a two-hour ride, Mr. Hsu and two classmates arrived at the home of Li Syu Yue-E, a 62-year-old who died of septic shock brought on by diabetes. Ms. Li Syu had asked that her body be donated to Tzu Chi, which froze it for use in a surgery simulation class.

"You want the family to understand what we're doing so they feel part of it," Mr. Hsu said. "We also learned about Teacher Li Syu. We got to know her as a person."

In late February, Mrs. Li Syu's body was unfrozen along with the other seven bodies to be used in a surgery simulation, one of four such workshops the school holds every year.

The night before the workshop was to start, some of the school's 350 medical students gave PowerPoint presentations about the lives of each donor to school staff and family members. When Mr. Hsu's group was up, a classmate showed pictures of Mrs. Li Syu, accompanied by a poem written by the classmates:

Like a warm lantern in our heart,

Like the supple light of the moon,

To embrace you forever

In the fragrance of a flower,

We will remember you forever

Then, Jeff Sun, head of the Tzu Chi hospital's surgery department, addressed the relatives. "The students are right next to you. They know how dear the departed are to you. They will treat them with respect."

The next day at dawn, Mr. Hsu stood, clad in a white uniform and surrounded by classmates, in a small, bright shrine on the university campus. Across the aisle were about 30 family members of eight donors. After a short service of Buddhist prayers, the two sides filed into the operating room. On a screen at the head of each of the eight operating tables was a photo of the deceased.

Slowly, family members broke down. Some prostrated themselves over the bodies, wailing. Others stood silently sobbing. Like many of the other medical students, Mr. Hsu's face began to turn red. He bit his lip as it started to quiver. His eyes welled up with tears. Across the table from him, Ms. Li Syu's daughter, Syu Yue-chen, looked at him appreciatively before everyone trooped out and the service concluded with more prayers. As family members headed home, Mr. Hsu and his classmates went back in to begin their work.

Four days later, the surgery workshop ended, and all reunited for the final funeral. The bodies were taken to a crematorium and the remains put in cut-glass urns donated to Tzu Chi by one of the island's most popular craftsmen, Heinrich Wang.

"This was her will, to let the students learn from her body," said Ms. Syu as she prepared to make her way back home to Hong Kong. "And maybe now I can accept it."

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